胆管引流或支架置入术后感染的病原学分析

Etiological analysis of infections after biliary drainage or stent implantation and countermeasures for diagnosis and treatment

目的探讨胆管引流或支架置入术后感染的病原菌分布及耐药性,并采取相应措施进行对症治疗,分析治疗后的效果。方法回顾性分析2011年1月-2013年1月56例胆管引流或支架置入术后感染患者的临床资料,对其进行病原菌检测,分析其病原菌分布及耐药性。结果胆管引流或支架置入术后感染的病原菌中共检出病原菌11种65株,其中革兰阴性菌37株占56.9%,革兰阳性菌28株占43.1%,革兰阴性菌中以铜绿假单胞菌最多,占23.1%,革兰阳性菌中以金黄色葡萄球菌最多,占20.0%;病原菌标本来源中以痰液最多见,占61.5%;37株革兰阴性菌对头孢曲松、亚胺培南、环丙沙星、头孢哌酮/舒巴坦、头孢他啶较敏感,敏感率均>60.0%,革兰阳性菌对替考拉宁、头孢米诺、万古霉素较敏感,敏感率均>70.0%。结论胆管引流或支架置入术后感染要针对病原菌类型选择敏感的抗菌药物对症治疗。

OBJECTIVE To explore the distribution of pathogens causing infections after biliary drainage or stent implantation, take corresponding measures for symptomatic treatment, and analyze the therapeutic effect. METHODS A retrospective analysis was performed for the clinical data of 56 patients with postoperative infections who underwent the biliary drainage or stent implantation from Jan 2011 to Jan 2013, then the pathogens were de- tected, and the distribution and drug resistance of the pathogens were analyzed. RESULTS Totally 11 species of pathogens （65 strains） have been isolated from the patients undergoing the biliary drainage or stent implantation, including 37 （56.9%） strains of gram-negative bacteria and 28 （43.1%） strains of gram-positive bacteria; the Pseudomonas aeruginosa was dominant among the gram-negative bacteria, accounting for 23.1%; the Staphylo- coccus aureus was the predominant species of gram-positive bacteria, accounting for 20.0%. 61.5% of the patho- gens were isolated from the sputum specimens. The drug susceptibility rates of the 37 strains of gram-negative bac- teria to ceftriaxone, imipenem, ciprofloxacin, cefoperazone-sulbactam, and ceftazidime were more than 60.0% while the drug susceptibility rates of the gram-negative bacilli to teicoplanin, cefminox, and vancomyci were more than 70.0%. CONCLUSION The susceptible antibiotics should be chosen for the symptomatic treatment based on the species of pathogens causing infections after biliary drainage or stent implantation.